Topics of the day:
1. Response to Dr. Sanoo; inherent edgewise disadvantages
Dear Dr. Sahoo and Colleagues,
The forces required to overcome the friction produced by the edgewise bracket make the posterior protraction you require difficult, if not impossible, to accomplish without undue anterior retraction. Nowhere in Angle's writing does he describe sliding teeth along the arch wire; it simply was not necessary for his purposes. However when this becomes necessary in contemporary orthodontics, the development of friction proves to be a major handicap to efficient tooth movement. I've been thinking about this for some time, and I'll elaborate farther on.
Posterior protraction in conjunction with miniscrews would be a solution to your problem. Other solutions might include bonding a lingual wire to all anterior teeth to reinforce your anterior anchorage. Placing an off-center bend just distal to your cuspids ala Mulligan would also help. One strategy that is often overlooked is bending a flush stop mesial to your molars and protracting your bicuspids separately. Once they are mesialized, place an off-center bend just distal to the bicuspids and then protract the molars. If your upper arch is well stabilized, Cl. II elastics could be helpful, although I never looked upon that procedure as terribly efficient for lower posterior protraction. Lastly, with a cooperative patient, a protraction face mask could solve your problem. As a learning experience, you might want to rethink your diagnosis. Would the case have been better served with the extraction of 2 nd bicuspids? (I'm assuming 1 st bicuspids were extracted.)
Your letter has given me the opportunity to discuss the merits of Tip-Edge. Let me say that your problem would have been less severe and quite possibly non-existent had you used the Tip-Edge system. I strongly recommend that you look at Richard Parkhouse's book, Tip-Edge Orthodontics (Mosby) to learn how this specific problem can be solved, as well as how this technique can greatly simplify your orthodontic life.
Those of you who have seen my previous postings know I am an avid Tip-Edge enthusiast. (Again, for the record, I have no financial interest in TP Orthodontics.) I wonder if it is simply lack of information that prevents most of you from evaluating the advantages that this system has to offer you. I am convinced that, in many cases, Tip-Edge can greatly simplify treatment for you and your patients.
There is no question that the edgewise appliance is capable of producing excellent results in all varieties of malocclusions. But I maintain that your use of the bracket has compelled you to accept, often unknowingly, certain undesirable features that not only limit the efficiency of the appliance, but oftentimes are non-physiologic as well. It is my view that the design of the Tip-Edge bracket can eliminate many of these shortcomings and provide a more effective and biologically efficient treatment.
What follows is an examination of the inherent disadvantages of the edgewise bracket:
a. It tends to deepen the bite.
b. There is an undesirable tendency for the cuspids to rotate.
c. It results in unsightly, albeit temporary, anterior spaces.
5. Midline correction requires individual tooth movement.
Tip-Edge eliminates all of these shortcomings, and I believe that Richard Parkhouse's book, Tip-Edge Orthodontics , will be an eye opener for most of you.
Edgewise has been and still is the major orthodontic technique of our profession. Faulting edgewise is like criticizing the American flag and mom's apple pie, so it's hard not to become defensives. But I have confidence in your objectivity, and I encourage you to learn more about Tip-Edge.
In 2004, after having been in practice for 18 years, I hired Paul Zuelke and Associates to get my practice straightened out. I wish I'd done it 17 years earlier! Hiring him, and later his wife Betty, are easily the best investments I've made in my practice. I recommend both of them highly (Betty may not be taking new clients at this time). I have absolutely no financial interest in this recommendation.
A resident just asked an interesting question: he is buying a small, urban/suburban practice with good potential. How should he market it or whom should he use to help him market it? Consultant, etc.
I use the stainless steel crown with a cantilever herbst and I can not remember any coming loose when I have utilize Fugi Blue Cement. The problem is that after I have removed the Herbst, the only way to remove the Fugi cement is to grind it off . A Scaler will not suffice alone and an ultrasonic scaler has been ineffective. I was placing Vasoline on the occlusal surfaces of the 1st molars but it made no difference. I love the cement but I hate the removal. Does anyone have any suggestions on removing the Fugi Blue Cement. I have used other cements and the removal is easier but there is an increase in loose crowns. I want to reiterate that I can't remember ever have a loose crown. A broken crown yes but no loose crowns.
Could anyone please tell me what's the best reliable technique, bonding materials and "etchants" for bonding to ceramic crowns? Thank you.
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